In recent years the formerly quite strong interest in patient compliance has been questioned for being too paternalistic and oriented towards overly narrow biomedical goals as the basis for treatment recommendations. In line with this there has been a shift towards using the notion of adherence to signal an increased weight for patients’ preferences and autonomy in decision making around treatments. This ‘adherence-paradigm’ thus encompasses shared decision-making as an ideal and patient perspective and autonomy as guiding goals of care. What (...) this implies in terms of the importance that we have reason to attach to (non-)adherence and how has, however, not been explained. In this article, we explore the relationship between different forms of shared decision-making, patient autonomy and adherence. Distinguishing between dynamically and statically framed adherence we show how the version of shared decision-making advocated will have consequences for whether one should be interested in a dynamically or statically framed adherence and in what way patient adherence should be assessed. In contrast to the former compliance paradigm (where non-compliance was necessarily seen as a problem), using observations about (non-)adherence to assess the success of health care decision making and professional-patient interaction turns out to be a much less straightforward matter. (shrink)
Tape-recorded semi-structured interviews were conducted with 21 nursing aides and enrolled nurses in the geriatric clinic in Umeå, Sweden. The interviews focused on the difference between the care of demented and non-demented patients and ethical conflicts in dementia care. The results indicate that caregivers have problems in providing the demented patients with opportunities to act autonomously in everyday matters on the ward, mainly due to the difficulty of understanding what the patients wish and the fact that their wishes, when understood, (...) often seem irrational. Measures to provide the demented patients with more opportunities to act autonomously in everyday matters are suggested. (shrink)
High-spin states in the odd-odd N = Z nucleus Co-54 have been investigated by the fusion-evaporation reaction Si-28(S-32,1 alpha 1p1n)Co-54. Gamma-ray information gathered with the Ge detector array Gammasphere was correlated with evaporated particles detected in the charged particle detector system Microball and a 1 pi neutron detector array. A significantly extended excitation scheme of Co-54 is presented, which includes a candidate for the isospin T = 1, 6(+) state of the 1f(7/2)(-2) multiplet. The results are compared to large-scale shell-model (...) calculations in the fp shell. Effective interactions with and without isospin-breaking terms have been used to probe isospin symmetry and isospin mixing. A quest for deformed high-spin rotational cascades proved negative. This feature is discussed by means of cranking calculations. (shrink)
Emotions are discrete, automatic responses to universally shared, culture-specific and individual-specific events. The emotion terms, such as anger, fear, etcetera, denote a family of related states sharing at least 12 characteristics, which distinguish one emotion family from another, as well as from other affective states. These affective responses are preprogrammed and involuntary, but are also shaped by life experiences.
This article analyses problem situations in the context of anaesthesia care. It considers what it means for nurse anaesthetists to be in problematic situations in the anaesthesia care of older patients. Benner’s interpretive phenomenological approach proved useful for this purpose. Paradigm cases are used to aid the analysis of individual nurses’ experiences. Thirty narrated problematic anaesthesia care situations derived from seven interviews were studied. These show that experienced nurse anaesthetists perceive anaesthesia care as problematic and highly demanding when involving older (...) patients. To be in problematic anaesthesia care situations means becoming morally distressed, which arises from the experience or from being prevented from acting according to one’s legal and moral duty of care. An important issue that emerged from this study was the need for an ethical forum to discuss and articulate moral issues, so that moral stress of the kind experienced by these nurse anaesthetists can be dealt with and hopefully reduced. (shrink)
This article reports an experimental study of decision-making outcomes in cooperative non-sidepayment games. The objective of this test was to determine which characteristic function, V α(S) or V β(S), provides the most accurate basis for payoff predictions from solution concepts. The experiment tested three solution concepts (core, stable set, imputation set) in the context of 5-person, 2-strategy non-sidepayment games. Predictions from each of the three solution concepts were computed on the basis of both V α(S) and V β(S), making a (...) total of six predictive theories under test. Consistent with earlier studies (Michener et al., 1984a; Michener et al., 1985), two basic findings emerged. First, the data show that for each of the solutions tested, the prediction from any solution concept computed from Vβ(S) was more accurate than the prediction from the same solution concept computed from V α(S). Second, the β-core was the most accurate of the six theories tested. Overall, these results support the view that V β(S) is superior to V α(S) as a basis for payoff predictions in cooperative non-sidepayment games. (shrink)
Two rotational bands have been identified and characterized in the proton-magic N = Z + 1 nucleus Ni-57. These bands complete the systematics of well-and superdeformed rotational bands in the light nickel isotopes starting from doubly magic Ni-56 to Ni-60. High-spin states in Ni-57 have been produced in the fusion-evaporation reaction Si-28(S-32, 2p1n)Ni-57 and studied with the gamma-ray detection array GAMMASPHERE operated in conjunction with detectors for evaporated light charged particles and neutrons. The features of the rotational bands in Ni-57 (...) are compared to those of neighbouring isotopes and interpreted by means of configuration-dependent cranked Nilsson-Strutinsky calculations. The two observed high-spin bands are considered signature partners and assigned to configurations with one 1g(9/2) proton and one 1g(9/2) neutron, resulting in an unambiguous understanding of the energetically favoured signature alpha = -1/2 band but a somewhat less satisfactory description of the signature alpha = +1/2 band. (shrink)
We present a dynamic programming model which is used to investigate hypothermia as an adaptive response by small passerine birds in winter. The model predicts that there is a threshold function of reserves during the night, below which it is optimal to enter hypothermia, and above which it is optimal to rest. This threshold function decreases during the night, with a particularly sharp drop at the end of the night, representing the time and energy costs associated with returning to normal (...) body temperature. The results of the model emphasise the trade-off between energy and predation, not just between foraging options, but also between foraging during the day and entering hypothermia at night. The value of being able to use hypothermia represents not just energy savings, but also reduced predation risk due to changes in the optimal foraging strategy. Conditions which give a high value of hypothermia are short photoperiod, variable food supply, low temperatures, poor and scarce food supplies. (shrink)
In ‘Parental Virtues: A New Way of Thinking about the Morality of Reproductive Actions’ Rosalind McDougall proposes a virtue-based framework to assess the morality of child selection. Applying the virtue-based account to the selection of children with impairments does not lead, according to McDougall, to an unequivocal answer to the morality of selecting impaired children. In ‘Impairment, Flourishing, and the Moral Nature of Parenthood,’ she also applies the virtue-based account to the discussion of child selection, and claims that couples (...) with an impairment are morally justified in selecting a child with the same impairment. This claim, she maintains, reveals that the flourishing of a child should be understood as requiring environment-specific characteristics. I argue that McDougall's argument begs the question. More importantly, it does not do justice to virtue ethics. I also question to what extent a virtue ethics framework can be successfully applied to discussions about the moral permissibility of reproductive actions. (shrink)
Adults who give proxy consent for medical treatment for adolescents must decide how much weight to give to adolescents' own preferences. There is evidence that some adolescents choose treatments different from what adults see as most reasonable. It is argued that adolescents choose according to age-specific values, i.e. values they hold, as adolescents, and which fulfil important developmental needs. Because not fulfilling these needs may do serious psychological damage, it is urged that proxies give weight to these values, up to (...) the limit where it would endanger or profoundly limit future life. (shrink)
Women wishing hospital admission for childbirth are asked to sign very general pre-admission consent forms. The use of such forms suggests that women in labor are considered incompetent to give informed consent. This paper explores some of the problems with advance directives and general consent, and argues that since women in labor are not generally incompetent, it is not appropriate to require this kind of consent of them.
Shakespeare’s play As You Like It shows explicitly the psychological and socialeffects of the bodily humors as they are enacted by each of the characters.The effects of pure humors in characters who have political power reverberatethrough the social order and force the politically subordinate characters torespond within their own humoral ability. The very stability of the purehumors creates instability throughout the social world. The humors actwithin what can be described as an economy, with exchange and resourcemanagement. This likeness to economic (...) functions gives rise, in this paper, toa discussion of the humors within recent and contemporary economics, andthe paper concludes that Rosalind's strategy of enacting multiple humors ina destabilizing manner allows for greater social stability. Economists, then,should consider strategic instability as a way to avoid “Minsky moments,”or the widespread instability that stems from too much stability. This hopefor controlled instability is developed through readings of works by JamesKenneth Galbraith, Hyman Minsky, and Paul Krugman among others. Thefinal suggestion is to work towards a more feminist conception of flow andinstability in economic theory and policymaking, with the hope of creating asystem more able to manage external shocks through the use of gendered andhumoral management strategies. (shrink)
In this special section, Ekman and Cordaro (2011); Izard (2011); Levenson (2011); and Panksepp and Watt (2011) have each outlined the latest instantiation of each lead author’s theoretical model of basic emotions. We identify four themes emerging from these models, and discuss areas of agreement and disagreement. We then briefly evaluate the models’ usefulness by examining how they would account for an emotion that has received considerable empirical attention but does not fit clearly within or outside of the basic (...) emotion category: pride. Finally, we compare the central themes covered by the four models with themes emerging from current emotion research, to conclude that, for the most part, the models are comprehensive; they largely converge with the current state of affective science research. (shrink)
This essay explicates and evaluates the roles that fetal metaphysics and moral status play in Rosalind Hursthouse’s abortion ethics. It is motivated by Hursthouse’s puzzling claim in her widely anthologized paper Virtue Ethics and Abortion that fetal moral status and (by implication) its underlying metaphysics are in a way, fundamentally irrelevant to her position. The essay clarifies the roles that fetal ontology and moral status do in fact play in her abortion ethics. To this end, it presents and then (...) develops her fetal metaphysics of the potential and actual human being, which she merely adumbrates in her more extensive treatment of abortion ethics in her book Beginning Lives. The essay then evaluates her fetal ontology in light of relevant research on fetal neural and psychological development. It concludes that her implied view that the late-stage fetus is an actual human being is defensible. The essay then turns to the analysis of late-stage abortions in her paper and argues that it is importantly incomplete. (shrink)
In this paper I discuss what contemporary virtue ethics can say about abortion by considering both what has been said and what we may further argue from a virtue-focused perspective. I begin by comparing virtue ethics to the two other dominant approaches in normative ethics and then consider what some important virtue ethicists have said about abortion, especially Rosalind Hursthouse. After recognizing the many contributions her analysis offers, I also note some of the deficiencies in her approach, particularly in (...) her attempt to bracket the problems of fetal status and women’s rights. Finally, in light of these criticisms I attempt to extend a virtue ethics analysis to embrace a more robust recognition of the humanity of the fetus and the attendant demand of a near absolute prohibition on abortion. (shrink)
Machine generated contents note: Introduction: The Rise of Philosophical Art Criticism 1 -- Chapter 1. In the Beginning Was Formalism 17 -- Chapter 2. The Structuralist Adventure 33 -- Chapter 3. The Historicist, Antiessentialist Definition of Art 55 -- Chapter 4. Resentment and Its Discontents 71 -- Chapter 5. The Deconstruction of Structuralism 87 -- Afterword: The Fate of Philosophical Art Criticism 111.